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Topic:Disease

The study of diseases in horses encompasses a wide range of conditions affecting equine health, including infectious diseases, metabolic disorders, and genetic abnormalities. These diseases can impact various systems within the horse, such as respiratory, gastrointestinal, and musculoskeletal systems, and can lead to significant health challenges. Research in this area focuses on understanding the pathophysiology, diagnosis, prevention, and treatment of equine diseases. Common diseases studied include equine influenza, equine herpesvirus, and laminitis. This page provides access to peer-reviewed research studies and scholarly articles that explore the etiology, clinical presentation, and management strategies of diseases in horses, contributing to the advancement of equine veterinary medicine.
Detection of equine influenza virus gene in the air around infected horses.
Veterinary microbiology    January 11, 2025   Volume 302 110388 doi: 10.1016/j.vetmic.2025.110388
Nemoto M, Kawanishi N, Kambayashi Y, Bannai H, Yamanaka T, Tsujimura K.Equine influenza virus (EIV) can be transmitted by inhalation of aerosolized droplets, direct contact, and contaminated fomites. However, to our knowledge, there are no reports of the recovery of EIV from the air surrounding infected horses. Here, we evaluated whether EIV can be recovered from the air in the stalls of experimentally infected horses by using an air sampler. Furthermore, we examined whether rapid molecular test kits with reaction times of less than 30 min can detect EIV from air samples for potential field application. Two horses kept in individual stalls were experimentally i...
Increased plasma nucleosomes are associated with severe sepsis in foals.
Veterinary journal (London, England : 1997)    January 9, 2025   Volume 309 106297 doi: 10.1016/j.tvjl.2025.106297
Birckhead EM, Raidal SL, Das S, Raidal SR.Sepsis is a main cause of death in neonatal foals. While the syndrome is not completely understood, sepsis is a dysregulated inflammatory response of the host to infection. It can be difficult to diagnose because of varying and non-specific clinical signs and imperfect diagnostic tests. Increased circulating nucleosome levels have been detected in humans and animals with sepsis, but this has not been documented in foals. Nucleosomes are released extracellularly during neutrophil extracellular trap formation, as well as from damaged and dead cells. We analysed plasma samples from clinically hea...
From Prediction to Precision: Explainable AI-Driven Insights for Targeted Treatment in Equine Colic.
Animals : an open access journal from MDPI    January 8, 2025   Volume 15, Issue 2 doi: 10.3390/ani15020126
Cetintav B, Yalcin A.Colic is a leading cause of mortality in horses, demanding precise and timely interventions. This study integrates machine learning and explainable artificial intelligence (XAI) to predict survival outcomes in horses with colic, using clinical, procedural, and diagnostic data. Random forest and XGBoost emerged as top-performing models, achieving F1 scores of 85.9% and 86.1%, respectively. SHAP (Shapley additive explanations) was employed to provide interpretable insights, offering both global and local explanations for model predictions. The analysis revealed that key features, such as pulse r...
Streptococcus hillyeri isolated from septic pleuritis in a horse. Albert E, Biksi I, Laczkó L, Miló L, Cseri K, Bőkényné Tóth R, Papp D, Halmay D, Bódai E, Bakos Z.Here we report the isolation of Streptococcus hillyeri from a thoracic sample from a horse. A 17-y-old Hungarian Sport Horse mare was referred to the equine clinic of the University of Veterinary Medicine Budapest, Hungary, with suspected pleuritis. Upon arrival, the horse was febrile and had tachycardia, severe inspiratory dyspnea, and tachypnea. Thoracic ultrasonography revealed severe bilateral pleural effusion, and a large area of lung consolidation. After sampling of both hemithoraces, 66 L of turbid exudate were drained. Based on these findings, a tentative diagnosis of septic pleuritis ...
Systemic calcinosis in horses: Pathological and genetic aspects.
Equine veterinary journal    January 6, 2025   doi: 10.1111/evj.14464
Carvalho Serena G, Marchezan Piva M, Viezzer Bianchi M, Fernandes da Fonseca HC, Chitolina Pupin R, Martins Basso R, Secorun Borges A....In horses, systemic calcinosis is a rare syndrome characterised by muscle lesion associated with the mineralisation of large muscle groups or other organs, in the absence of an alternative cause for the calcification, such as toxic, enzootic or metabolic. Molecular and histopathological aspects of the disease are still poorly elucidated. Objective: To describe the epidemiological, pathological and molecular aspects of systemic calcinosis in a convenience sample of six horses submitted to necropsy in the Southern and Midwestern regions of Brazil. Methods: Retrospective exploratory study. Method...
Uveitis and blindness in a closed herd of Equidae following leptospiral infection.
Frontiers in veterinary science    January 6, 2025   Volume 11 1504990 doi: 10.3389/fvets.2024.1504990
Gerras J, Young K, Roberts D, Waldman G, Salmon JH, Gilger BC.To describe the ocular findings, chronology of disease, and serum leptospiral titers in a group of horses, mules, and donkeys following an outbreak of leptospirosis. Unassigned: Fifty Equidae in central North Carolina had ophthalmic examinations and serum leptospiral microscopic agglutination test (MAT) titers performed every 3-6 months for 24 months followed by a final examination at 34 months. Unassigned: Throughout the nearly three-year study period, 17 horses (34%; 17/49 horses) developed signs of uveitis; 20 eyes (20/34; 58.8%) of these 17 horses were visual at the initial examinati...
Microbiological effect of topically applied Weissella cibaria on equine pastern dermatitis.
Frontiers in veterinary science    January 6, 2025   Volume 11 1493756 doi: 10.3389/fvets.2024.1493756
Styková E, Valocký I, Kačírová J, Fecskeová LK.Equine pastern dermatitis (EPD) is a multifactorial disease with a change in the skin microbiome. The present study monitored the influence of Weissella cibaria Biocenol™ 4/8 D37 CCM 9015 stabilized on alginite on the skin microbiota of healthy horses and model patients with EPD. Based on clinical signs, EPD lesions were identified as exudative or proliferative forms. A comparison of the initial microbial community based on 16S rRNA amplicon sequencing revealed that there was a statistically significant difference between healthy vs. exudative (R = 0.52, p = 0.003) and exudative vs. ...
Whole genome sequences of nine Taylorella equigenitalis strains isolated in the Czech Republic between 1982-2021: Molecular dating suggests a common ancestor at the time of Roman Empire.
PloS one    January 3, 2025   Volume 20, Issue 1 e0315946 doi: 10.1371/journal.pone.0315946
Hrala M, Andrla P, Bosák J, Fedrová P, Mugutdinov A, Karpíšková R, Nedbalcová K, Raichová J, Faldyna M, Hořín P, Šmajs D.Taylorella equigenitalis is the causative agent of sexually transmitted contagious equine metritis. Infections manifest as cervicitis, vaginitis and endometritis and cause temporary infertility and miscarriages of mares. While previous studies have analyzed this organism for various parameters, the evolutionary dynamics of this pathogen, including the emergence of antibiotic resistance, remains unresolved. The aim of this study was to isolate contemporary strains, determine their genome sequences, evaluate their antibiotic resistance and compare them with other strains. We determined nine comp...
Ethylene glycol toxicosis in 39 sport horses following ingestion of contaminated water: A case report.
Journal of equine veterinary science    January 2, 2025   Volume 145 105343 doi: 10.1016/j.jevs.2025.105343
Daradics Z, Bungărdean D, Lupșan AF, Popescu M, Bulmez O, Ciulu-Angelescu V, Chelaru VF, Morar I, Mircean M, Cătoi C, Tripon MA, Crecan CM.Ethylene glycol toxicosis is a common occurrence in dogs and cats but has been reported in other species as well. Up to date, only one case of ethylene glycol toxicosis has been described in horses, and specific guidelines for treating ethylene glycol intoxication in this species are not available. Here we describe the case of 39 sport horses that ingested water contaminated with ethylene glycol. The main clinical sign was apathy, but more severely affected individuals also developed abdominal pain and laminitis. Treatment was initiated around 24 h after the exposure, using ethanol as an antid...
Equine endometrial bacteria inhibition by metabolite and extracellular vesicles of Lactobacillus acidophilus and lactiplantibacillus plantarum.
Veterinary research communications    January 2, 2025   Volume 49, Issue 1 61 doi: 10.1007/s11259-024-10626-3
Bernabe MCM, Fonseca BB, Silva MVC, Pedrosa IE, Silva MB, Sommerfeld S, de Sousa ALP, de Leva Resende BC, Sousa ACP, Dos Santos Freitas A....Endometritis is one of the main reproductive disorders in mares and due to the increasing prevalence of antibiotic resistance, the use of probiotics in the prevention and treatment of endometritis in mares has gained interest, given their potential to restore and maintain a healthy uterine microbiota. Therefore, the aim of this study was to evaluate the antimicrobial properties of total metabolites of Lactobacillus acidophilus (LA) and Lactiplantibacillus plantarum (LP) against common equine endometrial pathogenic bacteria in vitro (Acinetobacter baumannii, Escherichia coli (1), Escherichia co...
Comparison of nasal swabs and handmade foam cubes for detecting equine herpesvirus 5 (EHV-5) by quantitative polymerase chain reaction (qPCR). Charbonnel A, Lavoie JP, Juette T, St-Sauveur VG, Denis S, Gagnon CA, Leclère M.The control of equine respiratory infections is a biosecurity challenge. Respiratory viruses are often rapidly detected using quantitative polymerase chain reaction (qPCR) on nasal swabs. In the past, some laboratories developed handmade techniques to increase the amount of nasal secretions collected, without comparing them with nasal swabs when qPCR replaced the use of viral culture. The objectives of this study were to compare nasal swabs and handmade foam cubes for i) the detection of a common equine herpesvirus (EHV-5) by qPCR, and ii) their tolerability. Forty-five polyester swabs and foa...
Could Serum Collectin-11, surfactant protein-A and D be suitable biomarkers for assessing pulmonary damage caused by Rhodococcus equi infection in foals on large farms?
Polish journal of veterinary sciences    December 30, 2024   Volume 27, Issue 3 355-362 doi: 10.24425/pjvs.2024.149367
Ekinci G, Deniz O, Tüfekci E, Timur MC, Onmaz AC, Günes V, Citil M, Keles I, Hoven RVD.Rhodococcus equi (R. equi) is a primary cause of pyogranulomatous pneumonia of foals between three weeks and five months of age. Early diagnosis of rhodococcal pneumonia has always been considered a preferable approach as it can lead to more successful treatment and better outcomes. Horse stud farms where the disease is common, neonatal foals are subjected to tests such as complete blood count and fibrinogen analysis at certain intervals. However, new biomarkers are needed in addition to blood count and fibrinogen measurement in this field for early diagnosis of diseases. Based on this need, i...
Foals born alive from mares with ultrasonographically assessed placental abnormalities: Neonatal health and development up to weaning compared to foals from healthy mares.
Theriogenology    December 29, 2024   Volume 235 31-38 doi: 10.1016/j.theriogenology.2024.12.025
Debes L, Venner M, Koether K, Vervuert I, Blanco M, Sieme H, Sielhorst J.Little is known about the health status of foals born alive from mares treated for placental disease. The aims of the present study were (1) to compare the neonatal health status and health development during the rearing period of foals born from mares treated for ultrasonographically assessed placental abnormalities (UPA) to age-matched healthy foals from the same warmblood stud and (2) analyze the influence of mare's placental health on colostrum quality. Foals (n = 127) born from mares with UPA (UPA group; P) in 2017-2019 were compared to 127 foals born from healthy mares (control group; ...
Prevalence, Associated Risk Factors, and Identification of the Genera of Equine Strongyles in Horses and Donkeys in and Around Bishoftu, Ethiopia.
Veterinary medicine international    December 28, 2024   Volume 2024 3224113 doi: 10.1155/vmi/3224113
Mulaw Berihun A, Bizu F, Maru M, Kassaw S.Equines play a significant role in the economy of the country. Besides their importance, equines face several challenges mainly helminth infections. Of these strongyle parasites are the most common, particularly in the study area. Thus, a cross-sectional study was conducted from February 2022 to July 2022 to determine the prevalence and associated risk factors and to identify the genera of equine strongyle parasites in and around Bishoftu. A total of 364 equines were randomly selected from five different areas and subjected to coprological examination using the floatation technique to detect s...
Evaluation of Theileria equi vertical transmission rate and routes in a cohort of asymptomatic mares and their foals.
Ticks and tick-borne diseases    December 25, 2024   Volume 16, Issue 1 102432 doi: 10.1016/j.ttbdis.2024.102432
Hermans LM, Bonsergent C, Josson A, Rocafort-Ferrer G, Le Guyader M, Angelloz-Pessey S, Leblond A, Malandrin L.Equine piroplasmosis is a tick-borne disease mainly caused by Theileria equi and Babesia caballi. The objectives of this study were to analyse the frequency and routes of vertical transmission of these blood parasites from 179 asymptomatic mares to their foals. Foals were sampled within 72 h post-partum. The seroprevalences determined by Indirect Immunofluorescent Antibody Test (IFAT) and based on a subset sample of 107 couples, were 59.8% and 42.1% for T. equi and B. caballi, respectively in the mare population, and 54.2% and 40.2% in the foal population. A species-specific nested PCR was per...
Molecular genotyping of Theileria spp. detected in horses from Corrientes City, Argentina.
Veterinary research communications    December 24, 2024   Volume 49, Issue 1 54 doi: 10.1007/s11259-024-10618-3
Benitez-Ibalo AP, Debárbora VN, Mangold AJ, Nava S, Sebastian PS.After the previous description and characterization of Theileria equi sensu stricto (Genotype A) in Argentina, the aim of the present study was to investigate the possible heterogeneity of 18 S rDNA genotypes circulating in this country. Therefore, blood samples from 18 horses from two different neighborhoods of Corrientes City, Corrientes Province, were analyzed for infection with Theileria species. Theileria DNA was detected in five samples (27.8%). Four nearly complete 18 S rDNA gene sequences were obtained and phylogenetic analyses were carried out. The maximum likelihood tree constructe...
Equine Infectious Anemia Virus Cellular Partners Along the Viral Cycle.
Viruses    December 24, 2024   Volume 17, Issue 1 5 doi: 10.3390/v17010005
Equine infectious anemia virus (EIAV) is the simplest described within the family, related to the human immunodeficiency viruses (HIV-1 and HIV-2). There is an important interplay between host cells and viruses. Viruses need to hijack cellular proteins for their viral cycle completion and some cellular proteins are antiviral agents interfering with viral replication. HIV cellular partners have been extensively studied and described, with a special attention to host proteins able to inhibit specific steps of the viral cycle, called restriction factors. Viruses develop countermeasures against ...
Gasterophilus in horses from Romania: diversity, prevalence, seasonal dynamics, and distribution.
Parasitology research    December 23, 2024   Volume 123, Issue 12 416 doi: 10.1007/s00436-024-08419-3
Rabei ȘO, Cârstolovean AS, Culda CA, Mihalca AD.This is the first study that targets the epidemiology of Gasterophilus spp. in slaughtered horses from Romania. Previously to our research, there were five recorded species: Gasterophilus haemorrhoidalis, Gasterophilus inermis, Gasterophilus intestinalis, Gasterophilus nasalis, and Gasterophilus pecorum with a dispersed distribution throughout the country, the data being recorded more than 73 years ago. The collection of Gasterophilus larvae was carried out from the digestive system (stomach, duodenum, and rectum) of horses in three abattoirs, monthly between January 2023 and December 2023. Fo...
Effect of refrigeration, room temperature, and processing time on serum immunofluorescent antibody titers for Sarcocystis neurona.
Journal of veterinary internal medicine    December 23, 2024   Volume 39, Issue 1 e17282 doi: 10.1111/jvim.17282
Valderrama-Martinez C, Packham A, Zheng S, Smith W, Plancarte M, Aleman M.Evaluating antibody titers for Sarcocystis neurona for the diagnosis of equine protozoal myeloencephalitis from serum samples is a common practice. However, ensuring timely and proper refrigeration is not always possible. Objective: To evaluate immunofluorescent antibody (IFA) titers for S. neurona from serum samples stored at room temperature and 4°C. Methods: Twenty-two serum samples. Methods: Prospective longitudinal study. Two serum aliquots of 1 mL each were stored at room temperature (20-23.3°C) and 4°C. The unrefrigerated aliquot was immediately tested for IFA titers. Both aliquots...
A comparative study evaluating three line immunoassays available for serodiagnosis of equine Lyme borreliosis: Detection of Borrelia burgdorferi sensu lato-specific antibodies in serum samples of vaccinated and non-vaccinated horses.
PloS one    December 23, 2024   Volume 19, Issue 12 e0316170 doi: 10.1371/journal.pone.0316170
Broeckl CV, Hiereth S, Straubinger RK.Diagnosis of equine Lyme borreliosis (LB), an infection caused by members of the Borrelia burgdorferi sensu lato complex (Bbsl), is challenging due to the nonspecific clinical signs of the disease and due to the variety of non-standardized serological tests. Specific vaccine-induced antibodies against LB, providing an effective protection against the infection, complicate the issue further. The standard for the detection of specific antibodies against Bbsl is a two-tier test system based on an enzyme-linked immunosorbent assay (ELISA) or indirect fluorescent antibody test (IFA) for antibody sc...
Positive correlation between interleukin (IL) 1 beta to IL-1 receptor antagonist levels in Standardbred racehorses prior to racing.
Veterinary immunology and immunopathology    December 23, 2024   Volume 280 110868 doi: 10.1016/j.vetimm.2024.110868
Chen JW, Stefanovski D, Haughan J, Jiang Z, Soma LR, Robinson MA.Interleukin 1 beta (IL-1β) and IL-1 receptor antagonist (IL-1RA) are both upregulated following traumatic injury. As IL-1RA blocks inflammatory signaling by IL-1β, overexpression of IL-1β relative to IL-1RA may drive inflammatory diseases. As such, determination of the relationship between IL-1β to IL-1RA expression levels in horses may provide insight into disease states or serve as a therapeutic readout of response to medical interventions. As techniques to detect plasma concentrations of IL-1β and IL-1RA in horses lack sensitivity, we developed and validated novel enzyme-linked immunos...
Effects of orally administered clioquinol on the fecal microbiome of horses.
Journal of veterinary internal medicine    December 22, 2024   Volume 39, Issue 1 e17276 doi: 10.1111/jvim.17276
Smith MZ, York M, Townsend KS, Martin LM, Gull T, Coghill LM, Ericsson AC, Johnson PJ.Whereas restoration of fecal consistency after treatment with clioquinol for chronic diarrhea and free fecal water syndrome has been attributed to its antiprotozoal properties, actions of clioquinol on the colonic bacterial microbiota have not been investigated. Objective: Characterize the dynamics of fecal microbial diversity before, during, and after PO administration of clioquinol to healthy horses. Methods: Experimental prospective cohort study using a single horse group. Methods: Eight healthy adult horses received PO clioquinol (10 g, daily) for 7 days. Feces were obtained daily for ...
The effect of lysophosphatidic acid on myometrial contractility and the mRNA transcription of its receptors in the myometrium at different stages of endometrosis in mares.
BMC veterinary research    December 19, 2024   Volume 20, Issue 1 571 doi: 10.1186/s12917-024-04384-2
Piotrowska-Tomala KK, Szóstek-Mioduchowska A, Jonczyk AW, Drzewiecka EM, Wrobel MH, Hojo T, Ferreira-Dias G, Skarzynski DJ.Endometrosis (chronic degenerative endometritis) results in morphological changes in the equine endometrium and impairs its secretory function. However, the effect of this condition on the myometrium remains unclear. Lysophosphatidic acid (LPA) may affect female reproductive function and embryo transport by influencing uterine contractility through its receptors (LPARs). The objective of this study was to determine myometrial LPAR1-6 mRNA transcription, and the effects of LPA on myometrial contractions in mares with endometrosis during the mid-luteal and follicular phases of the estrous cycle....
A Prioritized List of Veterinary Clinical Presentations in Dogs, Cats, and Horses to Guide Curricular Content, Design, and Assessment.
Journal of veterinary medical education    December 19, 2024   Volume 53, Issue 1 49-74 doi: 10.3138/jvme-2024-0093
Hinckley-Boltax AL, Malone E, Uustalu UK, FitzMaurice M.The Association of American Veterinary Medical Colleges competency-based veterinary education (CBVE) framework can be used to guide curriculum and assessment design and is intended to prepare veterinary graduates for Day One of clinical practice. However, while the framework defines curricular outcomes in terms of demonstrable competencies, it does not define the specific knowledge, skills, and attitudes required to achieve those outcomes. In some human medical curricula, prioritized lists of clinical presentations guide curricular content, design, and assessment. These lists are based, in par...
Retrospective cohort study on diseases and risk factors associated with death in hospitalized neonatal foals.
Journal of veterinary internal medicine    December 18, 2024   Volume 39, Issue 1 e17269 doi: 10.1111/jvim.17269
Castelain DL, Dufourni A, Pas ML, Bokma J, de Bruijn E, Paulussen E, Lefère L, van Loon G, Pardon B.The care of sick neonatal foals is labor-intensive and costly. Prediction of risk of death upon admission is often difficult but might support decision-making. Objective: To determine diseases and risk factors associated with death in neonatal hospitalized foals. Methods: Two hundred twenty-two hospitalized foals, ≤7 days old. Methods: Retrospective cohort study. Clinical and laboratory variables were evaluated for their association with death by means of Cox survival analysis and by classification and regression tree (CART) analysis. Results: Most prevalent diseases were sepsis (43.9%), e...
How to perform a transtracheal aspirate in horses for diagnosis of lower respiratory tract disease.
Journal of the American Veterinary Medical Association    December 18, 2024   1 doi: 10.2460/javma.24.11.0697
Bishop RC, Nobrega AD, Mersich I, Wilkins PA.To describe indications for and demonstrate the technique to perform a transtracheal aspirate in horses. Transtracheal aspirate is indicated to collect samples for cytology and bacteriologic culture in cases of suspected pneumonia or other lower respiratory tract disease. Methods: 1 healthy university-owned horse was used for demonstration purposes. Images of clinical case samples from the University of Illinois Veterinary Teaching Hospital are shown. Methods: The horse is restrained and sedated with detomidine or xylazine to facilitate restraint and butorphanol to minimize coughing. The ventr...
An ongoing concern: 20 years of research on equine atypical myopathy.
The Veterinary record    December 13, 2024   Volume 195, Issue 12 e5039 doi: 10.1002/vetr.5039
François AC, Renaud B, Kruse CJ, Marcillaud-Pitel C, Votion DM.Anne-Christine François, Benoît Renaud, Caroline-Julia Kruse, Christel Marcillaud-Pitel and Dominique-Marie Votion of the Atypical Myopathy Alert Group discuss insights from 20 years of research and surveillance on equine atypical myopathy.
Eastern Equine Encephalitis Virus: The Importance of Metabolism and Aging.
International journal of molecular sciences    December 12, 2024   Volume 25, Issue 24 13318 doi: 10.3390/ijms252413318
Kordowitzki P.Eastern equine encephalitis virus (EEEV) is a mosquito-transmitted alphavirus that, among humans, can cause a severe and often fatal illness. The zoonotic EEEV enzootic cycle involves a cycle of transmission between and avian hosts, frequently resulting in spillover to dead-end vertebrate hosts such as humans and horses. Interestingly, it has been described that the W132G mutation of the very low-density lipoprotein receptor (VLDLR), the receptor of EEEV, significantly enhanced the VLDLR-mediated cell attachment of EEEV. The patient's metabolism plays a pivotal role in shaping the complex lan...
Evidence of Influenza A(H5N1) Spillover Infections in Horses, Mongolia.
Emerging infectious diseases    December 11, 2024   Volume 31, Issue 1 doi: 10.3201/eid3101.241266
Damdinjav B, Raveendran S, Mojsiejczuk L, Ankhanbaatar U, Yang J, Sadeyen JR, Iqbal M, Perez DR, Rajao DS, Park A, Viana M, Murcia PR.Recent outbreaks of influenza A(H5N1) have affected many mammal species. We report serologic evidence of H5N1 virus infection in horses in Mongolia. Because H3N8 equine influenza virus is endemic in many countries, horses should be monitored to prevent reassortment between equine and avian influenza viruses with unknown consequences.
Immunodeficiencies in Foals.
The Veterinary clinics of North America. Equine practice    December 9, 2024   Volume 40, Issue 2S e1-e19 doi: 10.1016/j.cveq.2024.11.006
Magdesian KG.Knowledge of immunodeficiencies is crucial to neonatal medicine, in that they predispose to sepsis in the newborn and neonatal foal, as well as recurrent infections in older foals. The most common immunodeficiency in newborn and neonatal foals is failure of passive transfer, which is an example of an acquired immunodeficiency. Congenital or developmental immunodeficiencies may be transient or permanent, and can either affect the cell-mediated or humoral arms of immunity, and in some cases both. Affected foals often have chronic or recurrent respiratory or gastrointestinal infections, often wit...
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